Exploring patient participation in reducing health-care-related safety risks

probability proportional to population size and density. The respondents represented the
whole territory of the countries surveyed, according to the distribution of the resident
population. Interviews were conducted face to face in people’s homes and in their
national language. A total of 26 663 interviews were completed (12). The findings in
relation to actual experiences of Europeans are described in this section.
Adverse events
Twenty-six per cent of respondents said that they or a member of their family had
experienced an adverse event when receiving health care. Percentages were highest in
Sweden (49%), Denmark (43%), Latvia (43%) and the Netherlands (42%) and lowest in
Austria (12%), Portugal (13%), Italy (15%) and Bulgaria (15%).
More adverse events were reported by respondents who were aged between 40 and 54
years and were educated to a higher level, who worked as managers (compared to other
occupational groups) and who frequently had problems paying their bills.
Patients’ attitudes, involvement and experiences
There is increased interest in the role of the patient in safety management. Three
questions have been addressed in this chapter.
1. What are patients’ attitudes towards their involvement in patient safety?
2. What are the actual effects of involving patients in safety management?
3. What are the experiences of patients with respect to:
• the occurrence of adverse events;
• safety management in health care facilities; and
• being actively involved in safety management and feeling safe?
Attitudes
Patients seem to be rather conservative in defining their role. “The patient role is to
follow instructions” and “patients should expect competent care” are the two most
frequently mentioned comments in the qualitative study by Rathert et al. (1), although
it should be noted that this study was carried out among patients who had been in
hospital. The potential role of patients in an acute care setting such as a hospital should
not be overestimated. Many are not capable of active involvement, not even when
they are explicitly invited to be involved in, for instance, marking a surgical site or
questioning staff about hand washing. The studies described in this chapter show that it
is possible to stimulate a certain group of patients to ask about hand washing or mark a
surgical site, but confronting medical professionals and questioning medical authority is
something that many patients find difficult. In the experiments that have been described
in the relevant literature, about 91% of patients asked a nurse about hand washing,
but only 33% “dared” to ask a doctor. Netherlands patients, among whom roughly one
third stated that their doctor was never/sometimes willing to talk about things that had
gone wrong, also reported such responses. It should be borne in mind that people are
at their most vulnerable in a hospital setting and it is questionable whether they should
be encumbered with the additional burden of being responsible for ensuring their
own safety. Participation and involvement should not imply that professionals devolve
responsibility for safety to patients.
Patients’ experiences and patient safety
131